1. Introduction to Surgical INSTRUMENTATION
Concorde Career College

2. Objectives
Discuss the relationship between instrumentation, equipment, and supplies and quality patient care in the OR
Identify basic instruments by type, function, classification, and name

5. Manufacturing Most are stainless steel Carbon, chromium, iron, alloys
High carbon makes instruments harder and less likely to wear
Chromium increases resistance to corrosion

6. Manufacturing
Three types of finishing
Highly polished = increased resistance to corrosion, but increases glare from OR lights
Satin (dull) = less reflective, reduces glare
Ebonized = non-reflective, eliminates glare
Used for laser procedures because it prevents reflection of laser beam

7. CLASSIFICATIONS CUTTING/DISSECTING GRASPING/HOLDING CLAMPING/OCCLUDING
RETRACTING/VIEWING
PROBING
DILATING
SUTURING
SUCTIONING
ACCESSARY INSTRUMENTS

8. CUTTING/DISSECTING One or more sharp edges
Used for incision, sharp dissection, or excision of tissue
Include knives, scalpels, scissors, and bone cutting instruments – osteotomes, curettes, chisels, gouges, and rongeurs
May be classified as cutting instruments – saws, drills, biopsy punches, adenotomes, and dermatomes
-tome – refers to a cutting instrument

9. CUTTING/DISSECTING
The term knife and scalpel are interchangeable although typically scalpels have a detachable disposable blade and non-disposable handle and knives refers to non-disposable handle and blade such as an amputation knife
Scalpels handles sizes include #3, #4, #7, and #9; Beaver blade handle

10. CUTTING/DISSECTING Disposable blades are made from carbon steel
Blades should be loaded and removed with an instrument such as a needle holder
#10, #11, #12, #12B, #15, #15C, #20, #21, #22, #23, #25
Blades fit specific handles - #10, #11, #12, #12B, #15, #15C blades fit #3, #7, #9 handles

11. CUTTING/DISSECTING
#20, #21, #22, #23, #25 blades fit on a #4 knife handle
Any size Beaver blade will fit on a Beaver blade handle
#10 blades are the most frequently used blades and should be loaded on a #3 knife handle; do not load #10’s on a #7 knife handle
#11, #12, #15 blades are loaded on a #7 knife handle, although a #15 blade is used on a #3 knife handle for small skin incisions

12. CUTTING/DISSECTING
Blades become dull very quickly. 2 or 3 cuts usually dulls the blade
The blades have to be changed as needed
For safety reasons, if the blade has been changed, the surgeon should be informed that it is a new blade when passing it

13. CUTTING/DISSECTING Scissors
Tissue scissors, suture scissors, wire scissors, or bandage scissors
Tissue scissors should only be used to cut tissue because others materials will dull them; an exception would be CV surgeons, they use Metz to cut the small sutures
Wire scissors are used to cut wire
Bandage and straight mayo scissors can be used on dressings

14. Cutting and Dissecting14 14

15. CUTTING/DISSECTING
In addition to cutting tissue (sharp dissection), scissors are also used to spread and open tissue planes (dull dissection)
Curved mayo scissors are used on heavy tissue
Metz are used on medium to fine tissue
Iris, tenotomy, and Potts-smith scissors are used on delicate tissues

16. CUTTING/DISSECTING Examples of specialized scissors
Potts-smith – ducts, veins, or arteries
Cushing - dura
Jorgenson – hysterectomy
Strabismus, Iris, corneal scissors – eyes
Scissors have straight and curved blades and sharp or dull tips

17. GRASPING/HOLDING
Used to grasp or hold tissue for counter traction or manipulation
Forceps – aka pickups or thumb forceps
Forceps are usually used in the non-dominate hand
Forceps have either teeth, serrations or smooth; Vary in length
Adson – smooth, with teeth, or Brown tips; primarily used for skin closure
Ferris-Smith – used for heavy tissue
Brown, Russian, Gerald, Cushing, bayonet, rat tooth
Allis, Babcock, Kocher - clamps
Bone-holding clamps – ex; Lane, Kern, Lowen, Lewin

18. Grasping/holding
Designed to manipulate tissue to facilitate dissection or suturing or to reduce and stabilize fractured bone during internal fixation
Lowman – Turkey claw
Lane

19. CLAMPING/OCCLUDING Designed to occlude or restrict tissue
Have ringed handles with interlocking ratchets
Straight or curved, long or short, pointed or round
Vascular clamps have atraumatic serrations that are vertical
Bulldog clamps are small spring loaded for temporary occlusion – vascular
Hemostats are used to occlude bleeders until they can be ligated

20. Clamping and Occluding20 20

21. RETRACTING/VIEWING Designed for the exposure of the operative site
May be hand-held or self-retaining
Many sizes and designs; sharp or dull tips
Some retractors are malleable
Many hand-held are double-ended with a variation on each end and usually are mostly used two at a time

22. RETRACTING/VIEWING Most commonly used hand-held retractors –
small wounds - Richardson, Army/Navy, Senn, Ragnell,
A variety of rakes, skin hooks;
large wounds – Deaver, Ribbon (malleable), Harrington
Most common self-retaining retractors
small wounds – Gelpie, Weitlaner
large wounds – Balfour, Bookwalter, O’Sullivan-O’Conner
Many have a variety of attachments
Some large self-retaining retractors are attached to the OR table for stabilization

23. RETRACTING/VIEWING Viewing instruments are more specialized
Ear speculum; nasal speculum; vaginal weighted speculum
vaginal retractors
Endoscopes are also considered viewing instruments

24. PROBING
Malleable, wire-like instruments that are used for exploration of tubular structures
Fistula probes, lacrimal duct probes, biliary probe, rectal probes

25. DILATING
Used to gradually dilate a duct or an orifice to allow introduction of a larger instrument or open a stricture
Used from the smallest to largest
May require lubrication
Can be single or double ended
CBD, lacrimal duct, tracheal, urethral, cervical

26. SUTURING Used to hold a curved needle
– needle holders, needle drivers
Choosing an appropriately-sized needle holder depends on the size of the needle
the length depends on the depth
can be curved for deep tissue
Vary by specialty
General, ophthalmic, plastic, GYN, vascular, microscopic

27. Suctioning
Yankauer Suction
Poole Suction 27 27

28. SUCTIONING For the removal of blood and bodily fluids
Disposable and non-disposable
Vary by specialty
Abdominal, ear, neurosurgery, nasal, rectal
Some suction devices have the ability to coagulate
Many different lengths for trachea, esophageal, larynx – these are not typically used in sterile fashion

29. MICROINSTRUMENTATION
Used for working under the microscope
Small and delicate
Must be handled with extra care and precision

30. Introduction to Surgical INSTRUMENTATION
Concorde Career College

31. Objectives Describe different types of specialty sets
Describe types of instruments included in the sets
Describe procedures performed using specialty sets

32. Instrument Sets Assembled into sets for specific specialties
Assembled for specific procedures
Laparotomy
Craniotomy
Cardiovascular 32

33. Specialty Sets May contain a count sheet
Names of instruments may vary by manufacturer, locality, facility, or surgeon
Many procedures require more than one set

34. Laparotomy Sets Abdominal procedures
May need additional sets for certain procedures (gallbladder, rectal, etc)
Can be major or minor

35. Major Laparotomy Set

36. OB/Gyn D&C Abdominal hysterectomy Vaginal hysterectomy
Laparoscopic procedures
C-section

37. Abdominal Hysterectomy Set

38. D&C Set

39. ENT
Myringotomy
Tympanoplasty
Tonsils
Tracheotomy
Sinuses

40. ENT Instruments

41. Plastics
Lipo
Minor plastic
Major plastic
Breast Augmentation

42. Plastic Instrument Tray

43. GU
Kidney procedures may need a major set, basic vascular set, kidney set, long instrument set and a thoracotomy set
Prostate procedures may require several sets as well

44. What are these used for?

45. Ortho Internal fixation sets External fixation sets Minor ortho
Major ortho
Total joints
IM rods
Hands

46. Synthes ORIF Instruments

47. Cardiac sets
CABG- vein harvesting instrumentation, cannulization for bypass, diethrich scissors, sternal saw, IMA retractors, surgeon specific instrumentation

48. Thoracic sets Used for procedures of the thorax
Includes instruments to shear and remove ribs
Thoracoscopy sets differ from thoracotomy sets

49. Peripheral vascular Instruments for exposure and repair of vessels
Aneurysms, Fem-pops, A-V fistulas

50. Neuro
Exposure and repair of the brain, spinal cord, and peripheral nerves
Crani sets, lami sets, thrasphenoidal hypophysectomy sets
Cloward retractors

51. Craniotomy Instruments

52. Introduction to Surgical INSTRUMENTATION
Concorde Career College

53. Objectives Discuss the various uses for basic surgical instrumentation
Identify some commonly-used instruments

54. Farris Smith VERY traumatic Uses- closure of fascia
Nickname- Big Ugly, Mother-in-Law

55. DEBAKEY Atraumatic Uses- DELICATE TISSUE such as BOWEL
MOST COMMONLY USED FORCEP IN GENERAL SURGERY

56. HARRINGTON RET
Blunt edges
Uses- retracting the liver

57. GREEN RET
Uses – thyroid ret

58. LAHEY RET
Uses – thyroid ret

59. SENN RAKE RET Mostly used x 2 Sharp and dull
Uses- small incisions such as hands

60. POTTS-SMITH SCISSORS Vascular Billary tract explorations
Extending incisions

61. FREER ELEVATOR
Uses – removing periosteum from bone

62. METZENBAUM SCISSORS Uses – for fine or delicate dissection
The most commonly used scissors
DO NOT USE OR PASS FOR CUTTING SUTURE

63. FRAZIER SUCTION TIP
Uses – suctioning in small places

64. POOLE SUCTION Uses – suctioning irrigation
Changed on and off for laparotomies

65. DEAVER RETRACTOR
DEEP ABDONMINAL

66. RICHARDSON
OPENING AND CLOSING INCISIONS

67. STRIAGHT MAYO SCISSORS
Uses- cutting suture
Called “Suture scissors”

68. CURVED MAYO SCISSORS
Uses- cutting heavy tissue such as muscle, fascia, uterus

69. OSHNER/KOCHER
Traumatic
Uses- heavy tissue such as fascia or uterus

70. Hemostats Crile - Big bites of tissue such as mesentery
Kelly – Clamping of superficial vessels

71. BABCOCK
Atraumatic
Uses – clamping delicate tissue such as bowel, uterine tubes

72. ALLIS
Uses – medium tough tissue such as skin, mucusmembranous tissue

73. Adson Tissue Forceps
Uses – skin, specialty surgery

74. BODY-WALL RET
Uses – retracting the abdominal wall

75. LAHEY CLAMP
Very traumatic
UTERUS
THYROID

76. Passing Instruments
Passing the scalpel

77. Passing Instruments
Passing the scissors

78. Passing the tissue forceps
Passing Instruments
Passing the tissue forceps

79. Passing Instruments
Passing the hemostat

80. Passing Instruments
Hand signal for suture

81. Passing Instruments
Passing the suture

82. Instrument Care Handled with great care during all phases
Prevents injury
Extends the life of the instrument
Allows instrument to perform correctly 82

83. Instrument Sets Assembled into sets for specific specialties
Assembled into sets for physician preference (ie: Dr. Smith tubal set)
Assembled for specific procedures
Laparotomy
Craniotomy
Cardiovascular 83

84. Instrument Sets Names vary from one facility to another
Major tray versus laparotomy tray
Laparoscopy tray versus Pelviscopy tray
Ortho tray versus Bone tray 84

85. Instrument List/Count Sheet
Instrumentation
Instrument List/Count Sheet

86. Instrumentation
Preference Card

87. Instrument Care and Handling
Instrumentation
Instrument Care and Handling
The Instrument Cycle
Preoperative Phase
Intraoperative Phase
Postoperative Phase